Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical nutrition, enteral and parenteral nutrition

Managing patients with gastrostomy tubes in the community: Can a dedicated enteral feed dietetic service reduce hospital readmissions?

European Journal of Clinical Nutrition volume 66, pages 757–760 (2012)Cite this article

Subjects

Abstract

BACKGROUND/OBJECTIVES:

Post-gastrostomy complications range from 8 to 30%. These complications often occur following discharge into the community and may result in hospital readmission. Our unit previously reported a readmission rate of 23% in 6 months. There is a paucity of data evaluating community gastrostomy management. We therefore aimed to evaluate the benefits of a dedicated dietetic home enteral feed (HEF) team.

SUBJECTS/METHODS:

Demographic data, gastrostomy complications, readmission rates and HEF team input was prospectively collected from a cohort of discharged gastrostomy patients over a 1-year period and comparisons made with a similar historical cohort.

RESULTS:

A total of 371 complications were encountered in 313 gastrostomy patients during this period, with the commonest complication being over-granulated stoma sites (27%). Of these, 227 hospital admissions were avoided because of direct actions taken by the HEF team. Fifty-nine gastrostomy patients were admitted to the hospital, of which only seven (12%) were specifically for gastrostomy-related problems. Introduction of the HEF team significantly reduced gastrostomy-related hospital readmissions from 23 to 2% (P=0.0001).

CONCLUSION:

Although patients with gastrostomies may need attention to a variety of complex medical problems, many encounter problems specifically related to their gastrostomy after discharge. This is the largest prospective study demonstrating how dietitians trained in gastrostomy aftercare may optimize the management of gastrostomy complications and reduce unnecessary hospital readmissions.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Westaby D, Young A, O’Toole P, Smith G, Sanders DS (2010). The provision of a percutaneously placed enteral tube feeding service. Gut 59, 1592–1605.

    Article  Google Scholar 

  2. Norton B, Homer-Ward M, Donnelly MT, Long RG, Holmes GK (1996). A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ 312, 13–16.

    Article  CAS  Google Scholar 

  3. Mazzini L, Corra T, Zaccala M, Mora G, Del Piano M, Galante M (1995). Percutaneous endoscopic gastrostomy and enteral nutrition in amyotrophic lateral sclerosis. J Neurol 242, 695–698.

    Article  CAS  Google Scholar 

  4. Rabeneck L, Wray NP, Petersen NJ (1996). Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes. J Gen Intern Med 11, 287–293.

    Article  CAS  Google Scholar 

  5. Grant MD, Rudberg MA, Brody JA (1998). Gastrostomy placement and mortality among hospitalized Medicare beneficiaries. JAMA 279, 1973–1976.

    Article  CAS  Google Scholar 

  6. Cuerda C, Planas M, Gomez Candela C, Luengo LM (2009). Trends in home enteral nutrition in Spain: analysis of the NADYA registry 1992-2007. Nutr Hosp 24, 347–353.

    CAS  PubMed  Google Scholar 

  7. Jones B (2008). Annual BANS report 2008: artificial nutrition support in the UK, 2000–2007, http://www.bapen.org.uk.

  8. Johnston SD, Tham TC, Mason M (2008). Death after PEG: results of the National Confidential Enquiry into Patient Outcome and Death. Gastrointest Endosc 68, 223–227.

    Article  Google Scholar 

  9. Kobayashi K, Cooper GS, Chak A, Sivak Jr MV, Wong RC (2002). A prospective evaluation of outcome in patients referred for PEG placement. Gastrointest Endosc 55, 500–506.

    Article  Google Scholar 

  10. Callahan CM, Haag KM, Weinberger M, Tierney WM, Buchanan NN, Stump TE et al. (2000). Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting. J Am Geriatr Soc 48, 1048–1054.

    Article  CAS  Google Scholar 

  11. Loser C, Aschl G, Hebuterne X, Mathus-Vliegen EM, Muscaritoli M, Niv Y et al. (2005). ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG). Clin Nutr 24, 848–861.

    Article  Google Scholar 

  12. Schrag SP, Sharma R, Jaik NP, Seamon MJ, Lukaszczyk JJ, Martin ND et al. (2007). Complications related to percutaneous endoscopic gastrostomy (PEG) tubes. A comprehensive clinical review. J Gastrointestin Liver Dis 16, 407–418.

    PubMed  Google Scholar 

  13. Klein S, Heare BR, Soloway RD (1990). The ‘buried bumper syndrome’: a complication of percutaneous endoscopic gastrostomy. Am J Gastroenterol 85, 448–451.

    CAS  PubMed  Google Scholar 

  14. Healey F, Sanders DS, Lamont T, Scarpello J, Agbabiaka T (2010). Early detection of complications after gastrostomy: summary of a safety report from the National Patient Safety Agency. BMJ 340, c2160.

    Article  Google Scholar 

  15. Arrowsmith HL (1994). Discharging patients receiving enteral nutrition. Br J Nurs 3, 551–557.

    Article  CAS  Google Scholar 

  16. Scott F, Beech R, Smedley F, Timmis L, Stokes E, Jones P et al. (2005). Prospective, randomized, controlled, single-blind trial of the costs and consequences of systematic nutrition team follow-up over 12 mo after percutaneous endoscopic gastrostomy. Nutrition 21, 1071–1077.

    Article  Google Scholar 

  17. Sanders DS, Carter MJ, D’Silva J, McAlindon ME, Willemse PJ, Bardham KD (2001). Percutaneous endoscopic gastrostomy: a prospective analysis of hospital support required and complications following discharge to the community. Eur J Clin Nutr 55, 610–614.

    Article  CAS  Google Scholar 

  18. Gauderer MW, Ponsky JL, Izant Jr RJ (1980). Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 15, 872–875.

    Article  CAS  Google Scholar 

  19. Laasch HU, Wilbraham L, Bullen K, Marriott A, Lawrance JA, Johnson RJ et al. (2003). Gastrostomy insertion: comparing the options—PEG, RIG or PIG? Clin Radiol 58, 398–405.

    Article  Google Scholar 

  20. Sampson EL, Candy B, Jones L (2009). Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev 15, CD007209.

  21. Sanders DS, Carter MJ, D’Silva J, James G, Bolton RP, Bardhan KD (2000). Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol 95, 1472–1475.

    Article  CAS  Google Scholar 

  22. Department of Health (2009). Transforming Community Services: Ambition, Action, Achievement. Transforming Services for People with Long Term Conditions. DH: London.

  23. Best C, Hitchings H (2010). Enteral tube feeding—from hospital to home. Br J Nurs 19, 174, 176–179.

    Article  Google Scholar 

  24. Madigan SM (2003). Home enteral-tube feeding: the changing role of the dietitian. Proc Nutr Soc 62, 761–763.

    Article  Google Scholar 

  25. McNamara EP, Flood P, Kennedy NP (2000). Enteral tube feeding in the community: survey of adult patients discharged from a Dublin hospital. Clin Nutr 19, 15–22.

    Article  CAS  Google Scholar 

  26. Hampton S (2007). Understanding overgranulation in tissue viability practice. Br J Community Nurs 12, S24–S30.

    Article  Google Scholar 

  27. Lipp A, Lusardi G (2006). Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database Syst Rev 18, CD005571.

  28. Madigan SM, O’Neill S, Clarke J, L’Estrange F, MacAuley DC (2002). Assessing the dietetic needs of different patient groups receiving enteral tube feeding in primary care. J Hum Nutr Diet 15, 179–184.

    Article  Google Scholar 

  29. Brotherton AM, Judd PA (2007). Quality of life in adult enteral tube feeding patients. J Hum Nutr Diet 20, 513–522; quiz 523–525.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Sheffield, UK

    M Kurien, J Grant, D S Sanders & M E McAlindon

  2. Department of Dietetics, Royal Hallamshire Hospital, Sheffield, UK

    S White & G Simpson

Authors
  1. M Kurien
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S White
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Grant
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D S Sanders
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M E McAlindon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Kurien.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

This work was presented in abstract form as a poster at the British Society of Gastroenterology Annual Meeting (March 2011, Birmingham).Contributors: MK, SW, GS and JG were involved in writing the manuscript and data collection. DSS and MEMcA were responsible for initial study concept and revision of the final manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kurien, M., White, S., Simpson, G. et al. Managing patients with gastrostomy tubes in the community: Can a dedicated enteral feed dietetic service reduce hospital readmissions?. Eur J Clin Nutr 66, 757–760 (2012). https://doi.org/10.1038/ejcn.2012.19

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2012.19

Keywords

This article is cited by

Search

Advanced search

Quick links